Avoidant Personality Disorder

Detached Personality Disorder

What is Avoidant Personality Disorder?

This disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. It represents a "detached" personality pattern. Detached individuals are typically introverted, aloof and seclusive. An individual with avoidant personality disorder tends to avoid social activities and is usually quite uncomfortable in such activities when he or she is forced to participate. They have an extreme sensitivity to rejection, which may lead to social isolation and a withdrawn life. They tend to be shy, apprehensive, awkward and uncomfortable with face-to-face contact. An observer would describe them as timid, withdrawn, evasive and sometimes strange. Their speech has been described as slow and constrained. There are frequent hesitations and fragmented sequences of thought.

Persons with this disorder fear placing their welfare and feelings in the hands of others. They are hesitant to trust and confide in others. These individuals tend to be extremely introspective and self-conscious. They often perceive themselves as different from others and they tend to be unsure of their identity and self-worth. They tend to lack overall self-esteem. They will characteristically devaluate their own achievements, seeing themselves as isolated, discontent, and empty.

How is it diagnosed?

History: In a clinical interview, the most striking aspect is the individual's anxiety about talking with the interviewer. The psychiatric interview and mental status exam are the primary methods utilized by the practitioner. The physician looks for symptoms of a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. The avoidant personality exhibits a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts.

According to the DSM-IV, the individual will display four (or more) of the following:

  • avoids occupation activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection;
  • is unwilling to get involved with people unless certain of being liked;
  • shows restraint within intimate relationships because of the fear of being shamed or ridiculed;
  • is preoccupied with being criticized or rejected in social situations;
  • is inhibited in new interpersonal situations because of feelings of inadequacy;
  • views self as socially inept, personally unappealing, or inferior to others;
  • or is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Physical exam is not helpful in diagnosing this disorder.

Tests: There are a variety of psychological tests that can be performed to help identify and classify personality disorders. The interpretation of these tests are used in conjunction with the history.

How is Avoidant Personality Disorder treated?

The treatment for the avoidant personality disorder is dependent upon the therapist and individual establishing an alliance based on trust. Psychotherapeutic modalities utilized include group, behavioral (assertiveness training), and individual therapy. One of the goals of therapy is to encourage the individual to move out into the world to take what are perceived as great risks of humiliation, rejection, and failure. Pharmacotherapy has been used to deal with depression and anxiety, which are common features associated with avoidant personality disorder. Antianxiety agents may be useful in treating high levels of anxiety associated with this disorder.

Medications

Information Brand Generic Label Rating
Sertraline Zoloft Sertraline Off-Label
Klonopin Clonazepam Off-Label

What might complicate it?

Any type of rejection in the life of the avoidant personality may lead to increasing social withdrawal. Criticism in any form is usually devastating and intensifies the dysfunction. Other complicating factors are the presence of anxiety, depression, or other coexistent psychiatric disorders including substance abuse. At work or home, any type of rejection or perceived rejection usually leads to withdrawal.

Predicted outcome

Many individuals with avoidant personality disorder are able to function, provided they are in a protected environment. A stable support system and a positive network of family and friends usually insures a good outcome.

Alternatives

The personality traits found in the avoidant personality are closely related to schizoid personalities who have a tendency to isolate. There are shared traits also in the histrionic, borderline and passive-aggressive personality disorders, anxiety disorder, mood disorders, and it may be the precursor to schizophrenic disorders.

Appropriate specialists

Psychiatrist or psychologist.

Last updated 18 November 2011


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